Shariat - Figure 38
First Determination
FIG. 38: So, if a patient is diagnosed with NMI bladder cancer today, should the first determination be whether or not there is variant histology? This is an evolving field of medicine and research and we are constantly learning more. If urothelial variants, such as squamous/glandular or lymphoepithelial-like variants are present, the standard approach is to perform re-resection, with our decision-making then proceeding to BCG vs radical cystectomy, and most of these patients will be offered BCG intravesical therapy.[40]
If a micropapillary, plasmacytoid, or sarcomatoid variant is identified, then immediate radical cystectomy seems the best avenue of treatment. While these data are not yet sufficiently mature for guideline recommendations, this approach is strongly urged by many experts. Should other variants, such as small-cell carcinoma, be present, neoadjuvant chemotherapy is the mainstay of treatment, and if the patient responds, then local therapy, inclusive radical cystectomy, or radiation should be assessed.
References
Mochini M. Nat Rev Urol. In press
